AB1361 PAIN MANAGEMENT IN METASTATIC BONE DISEASE
Authors: B. A. Hiba, K. Dorra, R. Meriem, B. Chayma, K. Sonia, E. Hanen, K. Mahla, F. Raja, C. Elhem
Journal: Annals of the Rheumatic Diseases (2022)

Background Bone metastases are the most common cause of pain in patients with malignant disease. Bone metastasis (BM) pain management is one of the greatest challenges for oncologists, due not only to safety issues, but also to the significant impairment of patients’ quality of life and performance status. Objectives To provide an overview of the epidemiology, clinicopathological features and treatment approaches of painful BM in patients followed-up at the pain treatment center (PTC) of Tunisia. Methods We performed a retrospective review of the medical records of all patients with BM, seen at the PTC of Tunisia in 2019. The information collected included patient demographics, clinicopathological features and treatment approaches of the BM. Results A total of 117 patients, with male to female ratio of 2.5 and a mean age of 61,2± 12.5 years [22-93], were included. Primary cancers were mainly lung cancer (40%), breast cancer (13,7%), prostate cancer (11,1%), malignant hemopathies (5%) and kidney cancer (3,5%). Mean cancer duration was 10.5 months [0-84]. Mean duration from the diagnosis of cancer to the diagnosis of BM was 4.2± 1.7 months [0-11].The most common BM sites were the spine (83.6%), the pelvis (28.5%) and the ribs (22.4%). BM was painful in 97% of cases. The mean number of consultations at the PTC was 5.5±2.8 [1-18].Malignant bone pain was nociceptive in 73.3% of cases, neuropathic in 9.5% and mixed (both nociceptive and neuropathic) in 33%. Mean visual analogue scale (VAS) pain was 8.7±1,5 [2-10]. Most of the patients (84.5%) were treated by opioid analgesics which was morphine in 98% of cases. The route of administration of morphine was the oral in 85.3% of cases with a median dose of 60mg/j [10-240]. Laxatives and antiemetic therapy, in prevention of side effects of morphine, were prescribed in respectivly 87% and 28% of cases. The transdermal fentanyl patch was prescribed for three hepatically impaired patients. Only 15.5% of patients had a good response to pain killers palier II (Tramadol) and did not necessitate to switch to morphin. Mean dose of Tramadol was 178±75.1 mg [75-300]. Pregabalin was indicated in 25% of cases with a mean dose of 227.5± 127.7mg [150-600].Tricyclic antidepressants were prescribed for 9.5% of the patients and the mean dose was 16 ±10 mg [10-40]. Corticoisteroids were used in almost two-third of cases with a mean daily dose of 1mg/kg/j [0,5-1.5]. However, in 14% of cases, non-steroidal anti-inflammatory drugs were prescribed instead of corticosteroids. Bisphosphonates were used in 15% of cases. Antalgic radiotherapy was indicated in one-third of cases. By a median follow-up of 3 months [0-24], mean VAS pain was 3.7±1.7 [1-9]. Conclusion Currently, the treatment of painful BM remains palliative at best with systemic therapy as well as local treatments especially when BMs become symptomatic or complicated. Consequently, a multidisciplinary approach to BM is essential, to ensure a proper integration of local and systemic therapies Disclosure of Interests None declared